 |
Vietnam
Veterans of America
Lawrence
G. Brown Memorial Chapter
#896, Endicott,NY
|
 |
|
Membership is open to U.S.
armed forces veterans who served on active duty (for other than
training purposes) in the Republic
of Vietnam between February 28, 1961
and May 7, 1975, or in any duty location between August 5, 1964 and May
7, 1975. |
| |
|
APPLICATION FOR MEMBERSHIP
|
|
ATTENTION:
New members and new life members You must submit a copy of
your DD Form - 214 form along with this application and dues payment.
|
| Name: |
|
|
|
|
|
|
|
| |
| Address: |
|
| |
| City: |
|
State: |
|
Zip: |
|
| Home
Phone: |
Work
Phone: |
|
| E-Mail
Address: |
|
|
| Date
of Birth: |
Sex: |
|
|
| Optional: |
| Chapter
No. |
896 |
Sponsor: |
|
|
___ I
am already a VVA member and want to become a life member.
My VVA Member number is ______________ .
|
| Type of
Membership: |
| |
|
|
Life Member-Ages
49 and Under : $250 |
| |
Individual Member -1 year:
$20 |
|
Life Member-Ages
50-55: $225 |
| |
Individual Member- 3 years:
$50 |
|
Life Member-Ages
56-60: $200 |
| |
|
|
Life Member-Ages 61-65: $175 |
| |
|
|
Life Member-Ages
66+: $150 |
| |
|
|
Optional Time
Payment plan- $50 down, $25/month |
|
|
|
|
Payment Method: |
| |
|
|
Check |
| |
|
|
Money Order |
| |
|
Signature: |
|
|
|
|
|
|
Return
your completed application, payment, and a copy of your DD Form-214 to:
|
Vietnam
Veterans of
America
Lawrence G. Brown
Memorial Chapter 896
1405 Minor Circle
Endicott, NY 13760-1325 |
|
|
|
|
|
|